Developing and Validating a Novel Tool to Enhance Functional Status Assessment: The Tennessee Functional Status Questionnaire (TFSQ).

PURPOSE: Functional status is a major contributor to overall health and reflects both daily activity level (performance) and maximum attainable activity level (capacity). Existing assessment tools evaluate only 1 domain of function and do not provide insight into contributors to functional decline. We addressed these deficiencies by developing the Tennessee Functional Status Questionnaire (TFSQ), which reports activity levels in metabolic equivalents (METs) and evaluates 5 key areas: performance, capacity, activity, pain, and acute care. We validated the activity levels reported by the TFSQ against the Duke Activity Status Index (DASI). METHODS: In this prospective, observational study, 120 patients completed both the TFSQ and the DASI. TFSQ-reported functional performance and capacity was correlated with DASI-calculated METs. RESULTS: Pearson correlation between TFSQ-reported capacity and DASI-calculated METs was r = 0.69, P < .001. TFSQ capacity was significantly lower in patients who reported recently decreased activity, pain affecting function, or recent acute care exposure. CONCLUSIONS: The TFSQ is a brief and efficient assessment of patient function, standardized to METs and validated against the DASI. Our study suggests that many patients may have the functional reserve to increase daily physical activity and that factors such as changes in activity, pain, and recent acute care interaction may lower functional capacity.

Worse associative memory recall in healthy older adults compared to young ones, a face-name study in Spain and Mexico.

INTRODUCTION: The Face Name Associative Memory Exam (FNAME) is sensitive to associative memory changes early in the Alzheimer's disease spectrum, but little is known about how healthy aging affects FNAME performance. We aimed to assess aging effects on an extended version of the test, which captures further associative memory abilities beyond the recall and recognition domains measured in the original version. METHOD: We adapted FNAME versions in Spain and Mexico, adding new subtests (Spontaneous Name Recall, Face-Name Matching). We compared the performance of 21 young adults (YA) and 27 older adults (OA) in Spain, and 34 YA and 36 OA in Mexico. Recall was analyzed using a mixed-model ANOVA including subtest scores as dependent variables, age group as a fixed-factor independent variable, and recall subtest as a three-level repeated-measure independent variable. The rest of the associative memory domains were analyzed through t-tests comparing the performance of YA and OA. RESULTS: In Spain, we found significant effects for age group and recall subtest, with large effect sizes. The recognition subtests (Face Recognition, Name Recognition) displayed ceiling effects in both groups. The new subtests displayed medium-to-large effect sizes when comparing age groups. In Mexico, these results were replicated, additionally controlling for education. In both studies, recall performance improved after repeated exposures and it was sustained after 30 minutes in YA and OA. CONCLUSIONS: We document, in two different countries, a clear aging pattern on the extended FNAME: regardless of education, OA remember fewer stimuli than YA through recall subtests. The new subtests provide evidence on associative memory changes in aging beyond recall.

Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain).

BACKGROUND: There is a worldwide over-prescription of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), off-label prescribing, and unnecessary prescription of high doses. OBJECTIVES: Our aim was to assess the prescription rate of ICS and to identify sociodemographic and clinical factors associated with ICS prescription among patients with COPD, treated in Balearic primary healthcare. METHODS: This cross-sectional study included all patients with a clinical COPD diagnosis, who attended a primary care centre of the Balearic Islands (Spain) during 2012. Also, a sub-population with spirometry-confirmed COPD was defined. Data were obtained on patient demographics, smoking status, spirometry, ICS prescriptions, other respiratory medication, exacerbations and comorbidities. Associations with ICS and high-dose ICS prescription were assessed using multivariate regression analyses. RESULTS: In total, 15,440 patients were included (70% men, mean age 68.6 years), and 44.6% were prescribed ICS. The largest association with ICS prescription was asthma comorbidity (OR: 3.50; 95%CI: 3.12-3.92), followed by exacerbation history (OR: 2.23; 95%CI: 2.07-2.47). In addition, smoking status, spirometry, atopic dermatitis, allergic rhinitis and mean age were significantly (P < 0.001) associated with ICS treatment. In the spirometry-confirmed population, asthma (OR: 2.89; 95%CI: 2.29-3.64) and exacerbations were also the major factors (OR: 2.85; 95%CI: 2.45-3.32) followed by severe bronchial-obstruction (OR: 2.63; 95%CI: 2.24-3.08). High-dose ICS prescription was mainly associated with severe obstruction (OR: 2.27; 95%CI: 1.93-2.68). CONCLUSION: The percentage of COPD patients prescribed ICS in Balearic primary care is relatively low. Asthma comorbidity, exacerbation history, severe bronchial-obstruction, smoking status and a spirometry-confirmed COPD diagnosis were significantly associated with ICS prescription. [Box: see text].

Detección de especies de Salmonella y Mycobacterium en gaviotas dominicanas (Larus dominicanus) y gaviotas de Franklin (Leucophaeus pipixcan) en la ciudad de Talcahuano, Chile / Detection of Salmonella and Mycobacterium species in seagulls captured in Talcahuano, Chile

Background: Salmonella can be isolated from the feces of seagulls. Therefore these birds can be a vector for dissemination of this pathogen. Aim: To evaluate the possible role of gulls as vectors of two important human and animal pathogens (My-cobacteria and Salmonella). Material and Methods: One hundred twenty three Kelp gull (Larus dominicanus) and 60 Franklin gulls (Leucophaeus pipixcan) captured off the coast of the seaport of Talcahuano, were analyzed. Using traditional microbiological methods, the presence of Mycobacteria in cloacal swabs and feet lavages, was analyzed in both types of gulls. To detect the presence of Salmonella, feces, fecal and tracheal swabs, and feet lavage were analyzed from Franklin gulls. Feces, feet lavage, intestine, spleen, liver, kidney and lung, were examined in Kelp gulls. Results: All Mycobacteria cultures were negative. Salmonella enterica cultures were positive in 25 % of Kelp gulls and 6.7 % of Franklin gulls. Four serovars were identified by serotyping. Enteritidis and Senfteberg serovars were found in both types of gulls. Anatum and Infantis serovars were found only in Kelp gulls. Feces of gulls captured during the winter had the highest yield of positive cultures (36.1%). Conclusions: Seagulls are an important Salmonella vector in Chile.

[Detection of Salmonella and Mycobacterium species in seagulls captured in Talcahuano, Chile]. / Detección de especies de Salmonella y Mycobacterium en gaviotas dominicanas (Larus dominicanus) y gaviotas de Franklin (Leucophaeus pipixcan) en la ciudad de Talcahuano, Chile.

BACKGROUND: Salmonella can be isolated from the feces of seagulls. Therefore these birds can be a vector for dissemination of this pathogen. AIM: To evaluate the possible role of gulls as vectors of two important human and animal pathogens (My-cobacteria and Salmonella). MATERIAL AND METHODS: One hundred twenty three Kelp gull (Larus dominicanus) and 60 Franklin gulls (Leucophaeus pipixcan) captured off the coast of the seaport of Talcahuano, were analyzed. Using traditional microbiological methods, the presence of Mycobacteria in cloacal swabs and feet lavages, was analyzed in both types of gulls. To detect the presence of Salmonella, feces, fecal and tracheal swabs, and feet lavage were analyzed from Franklin gulls. Feces, feet lavage, intestine, spleen, liver, kidney and lung, were examined in Kelp gulls. RESULTS: All Mycobacteria cultures were negative. Salmonella enterica cultures were positive in 25 % of Kelp gulls and 6.7 % of Franklin gulls. Four serovars were identified by serotyping. Enteritidis and Senfteberg serovars were found in both types of gulls. Anatum and Infantis serovars were found only in Kelp gulls. Feces of gulls captured during the winter had the highest yield of positive cultures (36.1%). CONCLUSIONS: Seagulls are an important Salmonella vector in Chile.

[Angiomyolipomas, tuberous sclerosis and pregnancy]. / Angiomiolipomas, esclerosis tuberosa y gestación.

Renal angiomyolipomas are uncommon tumours during pregnancy, but it's important to consider them in the differential diagnosis, for the increased risk of complications such as bleeding, specially during pregnancy. Their characteristics are different depending on if the tumour is associated or not with facomatosis. To show both possibilities, we describe two cases of pregnant women with angiomyolipomas: the first one presented with bleeding of the tumour (Wünderlich's syndrome), but surveillance without treatment was possible until 37th week of gestation, and embolization of the tumour was performed afterwards. The second patient had multiple well known angiomyolipomas, associated to tuberous sclerosis; even though she had required two previous embolizations, she had an uneventful pregnancy, without any episodes of bleeding. Both pregnancies ended successfully by means of a cesarean section. Since there are few papers available in the literature, there is not an agreement about therapeutic management when pregnant women present with bleeding angiomyolipomas (Wünderlich's syndrome). Treatment options include partial or total nephrectomy (with cesarean section simultaneously in patients at 28 weeks of gestation or later), transcateter selective arterial embolization (which can also be preventive), and sometimes, conservative management. If this last option is possible, there's still discussion about the risk of vaginal delivery compared with that of cesarean section, in terms of bleeding of the tumour.

Estrés laboral / Job stress

Los autores investigaron los factores biosociales,laborales y familiares que se relacionan con la percepción de estrés laboral que presentan las profesoras de primer año básico de las Escuelas Municipales de la ciudad de Punta Arenas, en el año 2002.Es una investigación de tipo descriptivo, transversal, cuyo diseño metodológico utilizó u formulario de tres etapas: la primera, una "Escala de estrés con perspectiva de Género" (tipo Lickert), la segunda, un "Cuestionario de Factores de Estrés con perspectiva de género" y la tercera, "Escala de Holmes y Rahe" (adaptada).Se trabajó con un universo de 35 profesoras, cuyos criterios de inclusión fueron: ser profesora de sexo femenino, estar a cargo de un primer año básico, aceptación voluntaria de la profesora y autorización del Director del establecimiento para la realización del estudio.Los resultados permiten identificar y establecer la relación descriptiva entre los factores mencionados anteriormente, y así determinar la prevalencia de las profesoras que presentan percepción de estrés laboral desde una perspectiva de género.